Provider Demographics
NPI:1043390271
Name:ROBERT LITTLEJOHN MD
Entity Type:Organization
Organization Name:ROBERT LITTLEJOHN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-745-8766
Mailing Address - Street 1:180 1ST ST NW
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-745-8766
Mailing Address - Fax:330-745-9837
Practice Address - Street 1:180 1ST ST NW
Practice Address - Street 2:SUITE 5
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-745-8766
Practice Address - Fax:330-745-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35024053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5228191Medicaid
OHL10376521Medicare ID - Type Unspecified
OH5228191Medicaid